Counteracting the effects of invisibility in work with lesbian patients.

Lesbian women frequently experience "invisibility," the failure of others to recognize the significance of their sexuality and partnership relations. Such invisibility can have deleterious effects, such as a reduced ability to relate life stories to others and thereby to extend and integrate aspects of identity and its healthy complexity. Although this invisibility often is intertwined with coming-out phenomena, it continues to exist in many social contexts throughout life. Therefore, it is important for psychotherapists to recognize and understand the concept of invisibility so that they do not perpetuate it within the therapy. Several case vignettes are used as examples of how invisibility can affect a woman's life and functioning and can be counteracted in therapy.

Effect of different location of atrial lead position on nearfield and farfield electrograms in dual chamber pacemaker-defibrillators.

The normal functioning of dual chamber pacemaker-cardioverter defibrillator (AV pacer/ICD) may be affected by oversensing of the farfield R wave (FFRW) by the atrial channel. This study aimed to investigate whether placement of the AV pacer/ICD's atrial lead at a lateral (LAT) wall location compared to a medial (MED) location i.e. the appendage of the right atrium, would reduce the amplitude of FFRWs but not the nearfield atrial electrograms (AEGMs) during sinus rhythm (SR) and ventricular fibrillation (VF). In 17 patients, real time electrograms were recorded during SR and induced VF through the atrial lead initially at the MED and subsequently at the LAT location. In 10 patients the electrograms in SR were also recorded on a computerized data acquisition and recording system at different band-pass filter settings. Although FFRWs were recorded both at MED and LAT locations, they were much smaller, 3.5+/-4.1mm during SR and 1.7+/-2.2mm during VF at the LAT location. At 30-500Hz band-pass filter, lower amplitudes of FFRWs 0.14+/-0.09 mV were recorded at the LAT location. The V/A ratios of the amplitudes of FFRWs and AEGMs were smaller at the LAT location during SR and VF. The nearfield AEGMs were of similar amplitudes at the MED and LAT locations. These data indicate that lower amplitudes of FFRWs are recorded by placement of the atrial lead at the lateral wall of the right atrium. Oversensing of FFRWs may be prevented to improve functioning of the AV pacer-ICD.

Evidence of selective processing of immunodominant epitopes in virally infected cells.

Recent advances in clarifying the molecular mechanisms involved in Ag processing and presentation have relied heavily on the use of somatic cell mutants deficient in proteasome subunits, TAP transporter, and cell surface expression of MHC class I molecules. Of particular interest currently are those mutants that lack specific protease activity involved in the generation of antigenic peptides. It is theoretically possible that deficiencies of this nature could selectively prevent the cleavage of certain peptide bonds and thus generate only a subset of antigenic peptides. Gro29/Kb cell line is derived from the wild-type murine Ltk- cell line. This cell line is one example of a mutant that lacks specific protease activities. This deficiency manifests itself in an inability to generate a subset of immunodominant peptide epitopes derived from vesicular stomatitis virus and herpes simplex virus. This in turn leads to a general inability to present these viral epitopes to cytotoxic T lymphocytes (CTL). These studies describe a unique Ag processing deficiency and provide new insight into the role of proteasome-independent proteases in MHC class I-restricted peptide generation.